术前睑板腺理疗对睑板腺功能障碍患者白内障术后眼表的影响

目的：研究睑板腺功能障碍(MGD)患者术前行睑板腺理疗对白内障术后眼表的影响。

方法：采用前瞻性病例对照研究。选取我院2017-09/2018-07合并有MGD的白内障患者76例76眼，按照随机分组法分为两组，试验组术前1wk给予眼睑热敷、睑板腺按摩治疗(在院内进行一次全套治疗后，嘱患者每晚进行家庭热敷+睑板腺按摩治疗一次)，对照组不给予任何治疗。两组患者均行白内障超声乳化联合人工晶状体植入术。术前(试验组为行睑板腺理疗前)、术后1wk，1mo行眼表综合分析仪检查非侵入性泪膜破裂时间(NITBUT)、泪河高度(TMH)等，LipiView检查脂质层厚度(LLT)，并使用眼表疾病指数量表(OSDI)进行问卷调查。

结果：两组患者手术前后NITBUT、TMH、OSDI比较有差异(P<0.05)； 试验组及对照组术后1wk， 1mo NITBUT均较术前有明显降低(P<0.05)，其中对照组术后1wk，1mo NITBUT较试验组降低更为明显(P<0.05)。试验组TMH术后1wk较术前明显降低(P<0.05)，术后1wk基本恢复到术前水平(P>0.05)。试验组及对照组术后1wk，1mo OSDI均较术前有明显升高(P<0.05)，其中对照组术后1wk，1mo OSDI较试验组升高更为明显(P<0.05)。

结论：白内障超声乳化手术可破坏MGD患者的睑板腺功能及眼表状态，而术前行睑板腺理疗可以显著改善白内障术后MGD患者的眼表状态，并提高患者的满意度。

Effect of preoperative meibomian gland physiotherapy on ocular surface of patients with meibomian gland dysfunction after cataract surgery

AIM: To study the effect of preoperative meibomian gland physiotherapy on ocular surface after cataract surgery in patients with meibomian gland dysfunction(MGD).

METHODS: Totally 76 eyes of 76 cataract patients with MGD were selected and divided into two groups by random grouping method in our hospital. Patients in the experimental group was given eyelid hot compress and meibomian gland massage before operation(after a full set of treatment in the hospital, patients were instructed to have family hot compress and meibomian gland massage every night), and patients in the control group was not given any treatment. Cataract phacoemulsification and intraocular lens implantation were performed in both groups. The non-invasive tear break-up time(NITBUT)and the tear meniscus height(TMH)were examined by ocular keratograph, the thickness of lipid layer(LLT)were examined by LipiView, and the Ocular Surface Disease Index(OSDI)questionnaire was conducted at 1wk before operation and 1wk, 1mo after operation.

RESULTS: The NITBUT, TMH and OSDI were significantly different between the two groups before and after operation(P<0.05). The NITBUT were significantly lower than in both groups 1wk and 1mo after operation than those before operation(P<0.05). The NITBUT in the control group were significantly lower than those in the experimental group 1wk and 1mo after operation(P<0.05). The TMH was significantly lower one week after operation in the experimental group than those before operation(P<0.05), and returned to the preoperative level 1mo after operation(P>0.05). The OSDI were significantly improved after operation compared with those before surgery in both groups 1wk and 1mo(P<0.05). The OSDI in the control group were significantly higher than those in the experimental group 1wk and 1mo after operation(P<0.05).

CONCLUSION: Phacoemulsification of cataract can destroy the function of meibomian gland and the ocular surface condition in patients with meibomian gland dysfunction. However, preoperative meibomian gland physiotherapy can significantly improve the ocular surface condition of patients with meibomian gland dysfunction after cataract surgery, and improve the satisfaction of patients.